| Objective:This study used Delphi expert consultation method to construct risk assessment tool for adult ICU patients with pressure injury,and evaluated the reliability and validity of the risk assessment tool,reaction degree analysis,determine the boundary value and risk stratification,and explored its clinical applicability,so as to provide some reference for ICU nurses to prevent pressure injury,and then reduce the incidence of pressure injury in critically ill patients.Methods:The study was divided into two parts:(1)Delphi expert consultation stage,through a large number of literature review,combined with clinical practice,referring to the commonly used pressure ulcer risk factors assessment scores,through the discussion of the research group,select the high-risk factors suitable for adult ICU patients with pressure injury,and constitute the initial item pool of the assessment tool.The expert consultation form was constituted,20 experts from 10 different provinces and municipalities in critical care,nursing and nursing education were selected to conduct two rounds of consultation by e-mail.After consultation,statistical analysis opinions of all experts in each round was conducted,reliability and authority were tested,and the first-level items and grade items of the tool were finally determined to form a preliminary risk assessment tool for pressure injury.(2)In the evaluation stage of the tool,322 adult ICU patients who conformed to the inclusion and exclusion criteria were selected as the subjects for study.The risk assessment of pressure injury was carried out by using the pre-constructed assessment tool.The reliability,validity and responsiveness of the tool were analyzed.The predictive ability of the tool forpressure injury was determined by using the ROC curve.Through the percentage method to determine the risk stratification of the tool,the final formation of a complete "adult ICU patients with pressure injury risk assessment tool".Results:1.Formation of item pool of risk factors for pressure injury in adult ICU patientsBased on literature review and clinical practice,and referring to the commonly used risk factors assessment scores for pressure ulcer,13 high-risk factors associated with pressure injury in critically ill patients were screened.After discussion by the research group,the initial item pool including 12 risk factors was confirmed.2.Delphi Expert Consultation Method for Selection of ItemsThe recovery rate of the two rounds of expert consultation papers is 100%,the validity of the questionnaire is 100%,the authoritative coefficients of the two rounds of expert consultation are 0.863 and 0.872,and the Kendall's coefficients of the two rounds are 0.310 and 0.376,respectively,with statistical difference(P=0.000<0.001).In the first round of expert consultation,five items were deleted and five items were modified;In the second round of expert consultation,no item was deleted.Modify two items,and finally determine seven the first-level items and 25 grade items.Item assignment is based on 1 to 4 grade scoring system,The higher the score,the greater risk of pressure injury.3.The occurrence of pressure injury of the study subjectsIn this study,322 adult ICU patients were assessed,which were all effective.47 of them suffered from pressure injury,the incidence rate was 14.6%,most of them were stage 1 and stage 2 pressure injury.4.The evaluation results of tool(1)In the reliability evaluation,the total Cronbach'salpha coefficient of the tool was 0.683,and the Pearson correlation coefficient of the reliability among scorers was 0.993.In the reaction degree analysis,the average scores of the two groups with and without pressure injury were(16.34±3.11)and(12.66±3.33),with statistical difference(P=0.000).There was statistical significance except forthe age(P=0.089)and incontinence(P=0.156).(2)In the validity evaluation,the content validity index of tool level is 0.96,and the content validity index of item level is 0.75 to 1.00.In the structural validity evaluation,factor analysis extracts two common factors with eigenvalues>1,which can explain 54.034%of the total variance.The maximum factor load coefficient of "incontinence"itemis<0.4,the maximum factor load coefficient of other items is>0.4.The area under the ROC curve of the tool was 0.784 in predictive validity evaluation,which was significantly different from 0.5(P<0.001).(3)The diagnostic thresholds value of toolIn this study,the area under the ROC curve was 0.784,P=0.000<0.001,the highest Youden index was 0.481,sensitivity was 83%,specificity was 65.1%.Finally,the diagnostic threshold value of tool was determined to be 13 points,that is,when the evaluation result was more than 13 points,the patients had the risk of pressure injury.(4)The stratification of risk degreeBy percentage method,the risk level of tool was determined as follows:(1)13?total score ?15:it indicates that the risk of pressure injury is low in ICU patients;(2)16 ?total score?18:it indicates that the risk of pressure injury is medium in ICU patients;(3)Total score(?19):it indicates that the risk of pressure injury is high in ICU patients;Conclusion:The risk assessment tool constructed in this study has good reliability,validity and predictive ability,reasonable structure,moderate entries,and simple and convenient of clinical application.It can be used as a preliminary screening tool for assess the risk of pressure injury in adult ICU patients. |
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